Matsusaki Keisuke, Hirose Nobuyuki, Yamada Takuji, Morita Makoto, Okamoto Fumiki, Kawano Toyokazu, Miura Osamu, Okazaki Yukinori, Toda Tomohiro, Minamisono Yoshikazu, Nagasaki Susumu
Dept. of Surgery, Hofu Institute of Gastroenterology.
Gan To Kagaku Ryoho. 2008 Jun;35(6):995-7.
A 78-year-old woman underwent gastrectomy for type 3 gastric cancer with pyloric stenosis, which was detected in November 1997. Thoracic and abdominal CT and other diagnostic procedures were conducted regularly for 5 years after surgery. The patient was recurrence-free and her clinical course was satisfactory. Starting in early May 2005, however, she began to experience respiratory difficulty at exertion, which exacerbated rapidly thereafter. Examination at a department of respiratory physiology led to a diagnosis of a recurrence of stomach cancer and carcinomatous lymphangiosis+lymphatic metastasis to the peritoneal cavity. She was referred to us for palliative care. The accentuated respiratory difficulty was eased with oxygen inhalation and opioid administration. With improvement in her respiratory condition, a combination of S-1 80 mg/day, CDDP 10 mg x once/week and Lentinan 1 mg x twice/week, was initiated. Within about 2 weeks, her respiratory difficulty was eliminated and after 4 weeks x 2 courses, the tumor images were no longer recognized in the thoracic and abdominal CTs. The combination therapy of S-1/low-dose CDDP/Lentinan is free of evident adverse effects and may be a potent therapeutic alternative as a palliative therapy for malignant stomach cancers in elderly patients or those in a poor systemic condition.
一名78岁女性因1997年11月发现的伴有幽门狭窄的3型胃癌接受了胃切除术。术后5年定期进行胸部和腹部CT及其他诊断检查。患者无复发，临床病程令人满意。然而，从2005年5月初开始，她在用力时开始出现呼吸困难，此后迅速加重。在呼吸生理学科室检查后诊断为胃癌复发并伴有癌性淋巴管炎及腹膜腔淋巴结转移。她被转诊至我们科室接受姑息治疗。通过吸氧和使用阿片类药物，加重的呼吸困难得到缓解。随着呼吸状况改善，开始采用S-1 80毫克/天、顺铂10毫克×每周1次和香菇多糖1毫克×每周2次的联合治疗。约2周内，她的呼吸困难消失，经过4周×2个疗程后，胸部和腹部CT中不再能识别出肿瘤影像。S-1/低剂量顺铂/香菇多糖联合治疗没有明显不良反应，对于老年患者或全身状况较差的恶性胃癌患者作为姑息治疗可能是一种有效的治疗选择。
